Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T21:15:38.110Z Has data issue: false hasContentIssue false
  • English
  • Français

Distinguishing between depression and anxiety: A proposal for an extension of the tripartite model

Published online by Cambridge University Press:  16 April 2020

M.E. den Hollander-Gijsman ,
E. de Beurs ,
N.J.A. van der Wee ,
Y.R. van Rood  and
F.G. Zitman
M.E. den Hollander-Gijsman*
Affiliation:
Department of psychiatry, Leiden University Medical Center (LUMC), PO-box 9600, 2300 RCLeiden, The Netherlands Rivierduinen, PO-box 405, 2300 AKLeiden, The Netherlands
E. de Beurs
Affiliation:
Department of psychiatry, Leiden University Medical Center (LUMC), PO-box 9600, 2300 RCLeiden, The Netherlands Netherlands Institute of Forensic Psychiatry and Psychology (NIFP), PO-box 13369, 3507 LJUtrecht, The Netherlands
N.J.A. van der Wee
Affiliation:
Department of psychiatry, Leiden University Medical Center (LUMC), PO-box 9600, 2300 RCLeiden, The Netherlands
Y.R. van Rood
Affiliation:
Department of psychiatry, Leiden University Medical Center (LUMC), PO-box 9600, 2300 RCLeiden, The Netherlands
F.G. Zitman
Affiliation:
Department of psychiatry, Leiden University Medical Center (LUMC), PO-box 9600, 2300 RCLeiden, The Netherlands Rivierduinen, PO-box 405, 2300 AKLeiden, The Netherlands
*
*Corresponding author. Tel.: +31 0 715263785; fax: +31 0 715266964. E-mail address: [email protected] (M.E. den Hollander-Gijsman).
Get access

Abstract

Aim

The aim of the current study was to develop scales that assess symptoms of depression and anxiety and can adequately differentiate between depression and anxiety disorders, and also can distinguish within anxiety disorders. As point of departure, we used the tripartite model of Clark and Watson that discerns three dimensions: negative affect, positive affect and physiological hyperarousal.

Methods

Analyses were performed on the data of 1449 patients, who completed the Mood and Anxiety Symptoms Questionnaire (MASQ) and the Brief Symptom Inventory (BSI). From this, 1434 patients were assessed with a standardized diagnostic interview.

Results

A model with five dimensions was found: depressed mood, lack of positive affect, somatic arousal, phobic fear and hostility. The scales appear capable to differentiate between patients with a mood and with an anxiety disorder. Within the anxiety disorders, somatic arousal was specific for patients with panic disorder. Phobic fear was associated with panic disorder, simple phobia and social anxiety disorder, but not with generalized anxiety disorder.

Conclusions

We present a five-factor model as an extension of the tripartite model. Through the addition of phobic fear, anxiety is better represented than in the tripartite model. The new scales are capable to accurately differentiate between depression and anxiety disorders, as well as between several anxiety disorders.

Keywords

Tripartite modelDepressionAnxietyOutpatientsDimensionsQuestionnaires
Type
Original article
Information
European Psychiatry , Volume 25 , Issue 4 , May 2010 , pp. 197 - 205
Copyright
Copyright © Elsevier Masson SAS 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Publishing Inc; 1994.Google Scholar
Andrews, G.Comorbidity and the general neurotic syndrome. Br J Psychiatry 1996; 30: 76–84.CrossRefGoogle Scholar
Arrindel, W., Ettema, J.SCL-90: Handleiding bij een multidimensionele psychopathologie-indicator [SCL-90: Manual for a multidimensional indicator of psychopathology]. Lisse, the Netherlands: Swets & Zeitlinger; 1986.Google Scholar
Boschen, M.J., Oei, T.P.Factor structure of the Mood and Anxiety Symptom Questionnaire does not generalize to an anxious/depressed sample. Aust N Z J Psychiatry. 2006; 40(11–12): 1016–1024.CrossRefGoogle ScholarPubMed
Boschen, M.J., Oei, T.P.Discriminant validity of the MASQ in a clinical sample. Psychiatry Res. 2007; 150(2): 163–171.CrossRefGoogle Scholar
Buckby, J.A., Cotton, S.M., Cosgrave, E.M., Killackey, E.J., Yung, A.R.A factor analytic investigation of the tripartite model of affect in a clinical sample of young Australians. BMC Psychiatry. 2008; 8(79): 79.CrossRefGoogle Scholar
Buckby, J.A., Yung, A.R., Cosgrave, E.M., Cotton, S.M.Distinguishing between anxiety and depression using the Mood and Anxiety Symptoms Questionnaire (MASQ). Br J Clin Psychol 2007; 46(Pt 2): 235–239.CrossRefGoogle Scholar
Burns, D.D., Eidelson, R.J.Why are depression and anxiety correlated? A test of the tripartite model. J Consult Clin Psychol. 1998; 66(3): 461–473.CrossRefGoogle ScholarPubMed
Catell, R.B.The Screen test for the number of factors. Multivar Behav Res 1966; 1: 245–276.CrossRefGoogle Scholar
Chorpita, B.F.The tripartite model and dimensions of anxiety and depression: An examination of structure in a large school sample. J Abnorm Child Psychol. 2002; 30(2): 177–190.CrossRefGoogle Scholar
Clark, L.A., Watson, D.Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. J Abnorm Psychol 1991; 100(3): 316–336.CrossRefGoogle ScholarPubMed
De Beurs, E.De Brief Symptom Inventory; Handleiding [The Brief Symptom Inventory; Manual]. Leiden: Pits Publishers; 2005.Google Scholar
De Beurs, E., Den Hollander-Gijsman, M.E., Helmich, S., Zitman, F.G.The tripartite model for assessing symptoms of anxiety and depression: Psychometrics of the Dutch version of the Mood and Anxiety Symptoms Questionnaire. Behav Res Ther 2007; 45(7): 1609–1617.CrossRefGoogle ScholarPubMed
De Beurs, E, Den Hollander-Gijsman, ME, Van der Wee, NJA, Van Rood, YR, Giltay, EJ, Van Noorden, MS, et al.Routine Outcome Monitoring in the Netherlands: Practical experiences with a web-based strategy for assessment of treatment outcome in clinical practice. [Manuscript submitted for publication].Google Scholar
De Graaf, R., Bijl, R.V., Smit, F., Vollebergh, W.A., Spijker, J.Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. Am J Psychiatry. 2002; 159(4): 620–629.CrossRefGoogle ScholarPubMed
Derogatis, L.R., Lipman, R.S., Covi, L.SCL-90: An outpatient psychiatric rating scale-preliminary report. Psychopharmacol Bull. 1973; 9(1): 13–28.Google ScholarPubMed
Derogatis, L.R., Melisaratos, N.The Brief Symptom Inventory: An introductory report. Psychol Med. 1983; 13(3): 595–605.CrossRefGoogle Scholar
Floyd, F.J., Widaman, K.F.Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess. 1995; 7(3): 286–299.CrossRefGoogle Scholar
Joiner, T.E. Jr., Steer, R.A., Beck, A.T., Schmidt, N.B., Rudd, M.D., Catanzaro, S.J.Physiological hyperarousal: construct validity of a central aspect of the tripartite model of depression and anxiety. J Abnorm Psychol. 1999; 108(2): 290–298.CrossRefGoogle ScholarPubMed
Keogh, E., Reidy, J.Exploring the factor structure of the Mood and Anxiety Symptom Questionnaire (MASQ). J Pers Assess. 2000; 74(1): 106–125.CrossRefGoogle Scholar
Kessler, R.C., Chiu, W.T., Demler, O., Walters, E.E.Prevalence, severity, and comorbidity of 12-Month DSM-IV Disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005; 62(6): 617–627.CrossRefGoogle ScholarPubMed
Lecrubier, Y., Sheehan, D.V., Weiller, E., Amorim, P., Bonora, I., Sheehan, K.H.et al.The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997; 12(5): 224–231.CrossRefGoogle Scholar
Mineka, S., Watson, D., Clark, L.A.Comorbidity of anxiety and unipolar mood disorders. Annu Rev Psychol 1998; 49: 377–412.CrossRefGoogle ScholarPubMed
Nitschke, J.B., Heller, W., Imig, J.C., McDonald, P., Miller, G.A.Distinguishing dimensions of anxiety and depression. Cogn Ther Res. 2001; 25(1): 1–22.CrossRefGoogle Scholar
Perlis, R.H., Fava, M., Trivedi, M.H., Alpert, J., Luther, J.F., Wisniewski, S.R.et al.Irritability is associated with anxiety and greater severity, but not bipolar spectrum features, in major depressive disorder. Acta Psychiatr Scand. 2009; 282–289.CrossRefGoogle Scholar
Pasquini, M., Picardi, A., Biondi, M., Gaetano, P., Morosini, P.Relevance of anger and irritability in outpatients with major depressive disorder. Psychopathology. 2004; 37(4): 155–160.CrossRefGoogle ScholarPubMed
Picardi, A., Morosini, P., Gaetano, P., Pasquini, M., Biondi, M.Higher levels of anger and aggressiveness in major depressive disorder than in anxiety and somatoform disorders. J Clin Psychiatry. 2004; 65(3): 442–443.CrossRefGoogle ScholarPubMed
Shankman, S.A., Klein, D.N.The relation between depression and anxiety: An evaluation of the tripartite, approach-withdrawal and valence-arousal models. Clin Psychol Rev. 2003; 23(4): 605–637.CrossRefGoogle ScholarPubMed
Sheehan, D.V., Janavs, J., Baker, R., Harnett-Sheehan, K., Knapp, E., Sheehan, M.et al.MINI - Mini International Neuropsychiatric Interview - English Version 5.0.0 - DSM-IV. J Clin Psychiatry 1998; 59: 34–57.Google Scholar
Tomarken, A.J., Dichter, G.S., Freid, C., Addington, S., Shelton, R.C.Assessing the effects of bupropion SR on mood dimensions of depression. J Affect Disord. 2004; 78(3): 235–241.CrossRefGoogle ScholarPubMed
Van Vliet, I.M., Leroy, H., van Megen, H.J.G.M.MINI International Neuropsychiatric Interview; Dutch version 5.0.0.-R. Utrecht, the Netherlands: Department of Psychiatry, University Medical Center; 2000.Google Scholar
Watson, D., Clark, L.A.The Mood and Anxiety Symptoms Questionnaire. Iowa City: University of Iowa, department of psychology; 1991.Google Scholar
Watson, D., Clark, L.A., Weber, K., Assenheimer, J.S., Strauss, M.E., McCormick, R.A.Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult, and patient samples. Abnorm Psychol. 1995; 104(1): 15–25.CrossRefGoogle ScholarPubMed
Watson, D.Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. J Abnorm Psychol. 2005; 114(4): 522–536.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.